Provider Demographics
NPI:1013963875
Name:FISCO, DONALD A (DO)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:A
Last Name:FISCO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 JACKSON PIKE
Mailing Address - Street 2:
Mailing Address - City:GALLIPOLIS
Mailing Address - State:OH
Mailing Address - Zip Code:45631-1560
Mailing Address - Country:US
Mailing Address - Phone:740-395-8805
Mailing Address - Fax:740-395-8855
Practice Address - Street 1:280 PATTONSVILLE RD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:OH
Practice Address - Zip Code:45640-9452
Practice Address - Country:US
Practice Address - Phone:740-395-8805
Practice Address - Fax:740-395-8855
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-00-2714207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000174815OtherUNISON MEDICAID
OH0823676Medicaid
WV0043340000Medicaid
000000007643OtherANTHEM BCBS
080040481OtherRR MEDICARE
OH0823676OtherMOLINA MEDICAID
OH310917085037OtherCARESOURCE MEDICAID
001714054OtherMOUNTAIN STATE BCBS
001714054OtherMOUNTAIN STATE BCBS
OH0687823Medicare PIN
OH000000174815OtherUNISON MEDICAID